2012 olga's new hire presentation vo
TRANSCRIPT
2012 Employee Benefits2012 Employee Benefits
Presented by:
2012 Benefit Presentation2012 Benefit Presentation
•Benefit Overview
•How Do I Choose the Right Medical Plan?
•Other BenefitsVision, Dental, Life, AD&D & Disability
•Enrollment Timeframes
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2012 Benefit Overview2012 Benefit Overview• Medical Coverage – Health Plus - ww.healthplus.org
Cofinity PPO Network - www.cofinity.net
• Health Savings Accounts - PNC Bank
• Flexible Spending Accounts - TASC
• Vision – NVA (National Vision Administrators)
• Dental Coverage - Assurant
• Life and Disability Coverage - Mutual of Omaha
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Cofinity is a large Network of Providers that Health Plus offers to PPO Plan participants, making it easier to stay In-Network when obtaining services.
How To Choose the Right Medical Plan?How To Choose the Right Medical Plan?
1. Cost per pay check (Pre-tax)
2. Risk (Potential Out-Of-Pocket Cost), Plan Type & Design a. Provider Network & Access to Care
Health Plus (HMO) Cofinity (PPO)
b. Coverage Type & Plan Detail HMO (in-network ONLY) PPO (in and out-of-network coverage) High Deductible Health Plan (w/HSA) Standard Plan (w/FSA)
3. Health Care Spending Options (Pre-tax) HSA (Health Savings Account) FSA (Flexible Spending Account)
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How Much Does it Cost?How Much Does it Cost?
Enrollment Status
2012Health Plus
Standard HMOCost Per Pay
2012Health Plus
HDHP HMO HSACost Per Pay
Single $64.49 $21.26
2 Person $142.59 $45.33
Family $170.94 $54.22
Enrollment Status
2012Health Plus
Standard PPOCost Per Pay
2012Health Plus
HDHP PPO HSACost Per Pay
Single $73.91 $42.05
2 Person $163.78 $92.10
Family $196.36 $110.35
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HMO
PPO
Standard
HSA
Choosing the Right Plan:Choosing the Right Plan:PPO vs. HMO PPO vs. HMO
PPO CoverageIn and Out-of-network benefits availableNo primary care physician requiredHigher per pay check cost than HMO
HMO CoverageIn-network benefits ONLY Must choose a primary care physicianReferrals Required (12 month option)Less per pay check cost than PPOLarge provider network throughout Michigan
*Preventive care available in all plan options at no cost to the employee (no max; no copay)
*Adult children up to age 26 can be covered regardless of student, marital or earnings status.
Find providers atwww.cofinity.net
Find providers atwww.healthplus.or
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Choosing the Right Plan:Choosing the Right Plan:HDHP w/HSAHDHP w/HSA
2 Options: HMO or PPO
Plans require deductibles be met in full prior to coverage (except for preventive care at 100%)
Coinsurance & Rx co-pay begin AFTER deductible is met
All out-of-pocket expenses accumulate to maximum out-of- pocket
Contracts with two or more MUST meet full Family deductible amount before coverage begins (except for preventive care).
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HDHP (w/HSA) HDHP (w/HSA) PPO or HMOPPO or HMO
In-Network In-NetworkCofinity
Out-of-Network
Deductible $2000/$4000 $2,500/$5,000 $10,000/$20,000
Coinsurance 80% 90% 70%
Coinsurance Maximum
$2,000/$4,000 $2,500/$5,000 $10,000/$20,000
Preventive Health Services
100% 100% 70% of Reasonable and Customary
Charges
Office Visits $15 Copay After Deductible
$5 Copay After Deductible
70% After Deductible
Specialist Office Visits
$15 Copay After Deductible
90%After Deductible
70% After Deductible
Emergency Room
$100 CopayAfter Deductible
90% After Deductible
90% After Deductible
Urgent Care Facility Services
$50 CopayAfter Deductible
90% After Deductible
90% After Deductible
In-Patient Hospital
80% After Deductible
90% After Deductible
90% After Deductible
PPOHMO (HealthPlus)
Plans require copays for Rx, office visits, ER visits, etc., AFTER Deductible that DO count to out-of-pocket maximum.
8*See Details in Access Point
HDHP(w/HSA) HDHP(w/HSA) PPO or HMO:PPO or HMO:
Prescription Drug Coverage Prescription drug coverage is based on the use of a medication formulary
Copays apply to each prescription you fill (AFTER deductible is met):
o $15 for Generic drugso $60 for Brand Name drugs
Contraceptive drugs and implantable contraceptive drugs are included
Prescription Mail Ordero $30 for Generic drugs/$120 for Brand Nameo Filled for up to 90 days
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What is a Health Savings What is a Health Savings Account?Account?
Two components that work together to meet our personal healthcare needs.
Health Deductible Health Plan (HDHP) Preventive care covered 100%
Health Savings Account (HSA) Employee allocates to HSA Employee controls HSA May roll balance over at year-end
HSAHSAHSAHSA
Member Member ResponsibilityResponsibility Member Member ResponsibilityResponsibility
$$
HDHP
Pre
ven
tive C
are
10
0%
Deduct
ible
&
Coin
sura
nce
You must deposit $1/month to receive Olga’s contribution of $20, $40, or $60 /month into your HSA, based on enrollment status.
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2012 HSA LimitsSingle: $3,100Family: $6,250
Age 55+: $1,000
Eligible Expenses with Eligible Expenses with HSAHSA
Most out-of-pocket health care expenses:
•Deductibles & Coinsurance •Medical, Dental and Vision •Prescription drug costs•Some over-the-counter medications
(with prescription)•COBRA and Medicare premiums•Qualified long-term care insurance and expenses
*Remember*What is not used,
rolls over to the next year!11
HMO or PPOHMO or PPOStandard PlansStandard Plans
In-Network In-NetworkCofinity
Out-of-Network
Deductible $750/$1,500 $1,500/$3,000 $3,000/$6,000
Coinsurance 80% 80% 60%
Coinsurance Maximum
$3,000/$6,000 $3,000/$6,000 $6,000/$12,000
Preventive Health Services
100% 100% 60% of Reasonable and Customary
Charges
Office Visits $20 Copay $20 Copay 60% After Deductible
Specialist Office Visits
$20 Copay $40 Copay 60% After Deductible
Emergency Room $100 Copay $100 Copay 80% After Deductible
Urgent Care Facility Services
$35 Copay $50 Copay 60% After Deductible
In-Patient Hospital 80% After Deductible
80%After Deductible
60%After Deductible
Prescription CopayMail Order 2X, 90 Day
$10/$40 $15/$50 $15/$50Pay & Receive
Reim.
PPOHMO (HealthPlus)
Plans require copays for Rx, office visits, ER visits, etc., that do NOT count toward maximum out-of-pocket.
12*See Details in Access Point
Flexible Spending Accounts Flexible Spending Accounts
Health Care Reimbursement Account - $4,000Funded with pre-tax payroll deductionsCovers medical, prescription drug, dental and vision.
Dependent Care Reimbursement Account - $5,000
Funded with pre-tax payroll deductions
These are “use it or lose it” accounts, so
please be conservative with
your elections.
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You must deposit $1/month to receive Olga’s contribution of $20, $40, or $60 /month into your FSA, based on enrollment status.
Vision Summary Vision Summary National Vision AdministratorsNational Vision Administrators
In-Network Out-of-Network
ExamOnce Every 12 Months
Covered 100%After $10 Co-pay
(Reimbursed Amounts)Up to $52
LensesOnce Every 12 Months
Standard Glass or PlasticCovered 100%
After $25 Copay
Single Vision Up to $55Bi-focal Up to $75Tri-focal Up to $95
Lenticular Up to $125
FrameOnce Every 24 Months
Covered up to $130Retail Allowance
(Additional discount on the balance may apply at some providers)
Up to $80
Contact LensesOnce Every 12 Months
Elective:Covered Up to $130 Retail
Allowance(Additional discount on the balance
may apply at some providers)
Medically Necessary:Covered at 100%
Elective:Up to $130
Medically Necessary:$210
Visit www.e-nva-com
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To Find an NVA Provider:https://www.e-nva.com/nva/content/tourist/JSFPEntryTouristPage.jsf
Sample Group/Sponsor Number: 50981000101
Dental – Assurant PPODental – Assurant PPOHIGH PLAN In-Network Non-network
Deductible $0 $50/$150
Type I 100%Not Applied to Annual Max
100% after deductibleNot Applied to Annual Max
Type II 90% 80% after deductible
Type III* 60% 50% after deductible
Annual Maximum $1000 $700
Reasonable & Customary Fee Schedule 90th percentile
LOW MAC PLAN In-Network Non-network
Deductible $50/$150 $100/$300
Type I 100% No Deductible
70%
Type II 80% after deductible 50% after deductible
Type III 60% after deductible 20% after deductible
Annual Maximum $700 $500
Reasonable & Customary PPO Fee Schedule 45% less than PPO Fee Schedule15
How Much Does it Cost?How Much Does it Cost?
Enrollment Status
2012Assurant Dental
High PlanCost Per Pay
Single $8.47
2 Person $17.44
Family $29.71
Enrollment Status
2012NVA Vision Plan
Cost Per Pay
Single $2.75
2 Person $4.95
Family $7.15
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Enrollment Status
2012Assurant Dental
Low Mac PlanCost Per Pay
Single $3.10
2 Person $7.43
Family $15.43
Life & Life & Accidental Death & Accidental Death & Dismemberment – Mutual of Dismemberment – Mutual of OmahaOmaha
Core Life & AD&D benefit provided by Olga’s at no cost to you.◦ Benefit is 1X annual salary to $50,000
Voluntary Coverage (Life Only)◦ Up to 5X base annual earnings in increments of
$10,000◦ All increases in coverage require evidence of
insurability
Voluntary Dependent Life Available
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Disability Disability Mutual of OmahaMutual of Omaha
Short-Term Disability 60% of weekly earnings to a maximum of $500Payable on the 8th day for up to12 weeksCompany Paid
Long-Term Disability 60% of monthly earnings to a maximum of $5,000Payable on the 90th dayCompany Paid
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Access PointAccess PointConvenient Online EnrollmentConvenient Online Enrollment
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Enrollment Begins:
On Date of Hire
Enrollment Ends:
Within 2 Weeks
Benefits become active the first of the month following 30 days of full time employment.
An HR Representative will contact you with enrollment details.
Questions?Questions?
Please Contact:Roni [email protected](248) 362-9398
Lisa [email protected](248) 362-9377
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Thank You!
Carrier Contact Carrier Contact InformationInformation
DENTALAssurant Employee Benefits(800) 733-7879www.assurantemployeebenefits.comClaims.dental@assurant.comClaims Address:PO BOX 2940 Clinton, IA 52733
VISIONNVA – National Vision [email protected] Adress:P.O. Box 2187Clifton, NJ 07015
HEALTH SAVINGS ACCOUNTSPNC Bank(866) 622-3946www.pnc.com
Claims Address:PO BOX 1234Pittsburgh, PA 52733
LIFE & DISABILITYMutual of Omaha(800) 775-1000www.mutualofomaha.comClaims Address:Mutual of Omaha Insurance CompanyMutual of Omaha PlazaOmaha, NE 68175
FLEXIBLE SPENDING ACCOUNTSTASC(800) 422-4661www.tasconline.comClaims Address:FSA ReimbursementPO BOX 7308 Madison, WI 53707-7308
MEDICAL & RX Health Plus(800) 332-9161www.healthplus.orgwww.cofinity.net
Claims Address:P.O. Box 1700 Flint, MI 48501-1700
Mail Order DrugsExpress Scripts(877) 322-8471www.express-scripts.com